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Rhondali W.,Center Hospitalier Of Lyon Sud | Rhondali W.,University of Houston | Berthiller J.,Pole Information Medicale Evaluation Recherche | Hui D.,University of Houston | And 5 more authors.
BMJ Supportive and Palliative Care | Year: 2014

Purpose Palliative care (PC) needs expansion of its research capacity to improve the quality of care. This is particularly true for France that contributed less than 2% of all European PC research publications. We conducted a survey to assess the barriers French healthcare professionals (HCPs) involved in PC research had to face. Methods We surveyed all 420 PC departments registered in the French National Association for Palliative Care (SFAP) database using a previously used questionnaire. We documented the ethical limitations, time constraints, financial resources, patient issues and methodological issues related to PC research. Results We obtained 382 responses. Ninety-two (24.1%) HCPs were involved in a research project during the last 5 years. In univariate results, predictors of being involved in PC research were men (p=0.004), physician (p=0.022), working at a university hospital (p<0.001). There was a trend towards working in a PC unit (p=0.052). The main barriers to participating in PC research were lack of time (80.1%) and patient issues (47.4%). Lack of methodological support (33.0%) and financial limitations (30.4%) were also reported as major barriers. Conclusions There is a consensus that PC research and publication in the English language for peerreviewed journals must be expanded in France but at this stage, clinical teams still lack specific funding and appropriate support. More research is needed to confirm our results and to determine the best ways to develop PC research capacity in France. Source

Guibal A.,Service dImagerie Abdominale | Boularan C.,Service dImagerie Abdominale | Bruce M.,Service dImagerie Abdominale | Bruce M.,SuperSonic Imagine | And 7 more authors.
European Radiology | Year: 2013

Objectives: To determine the elasticity characteristics of focal liver lesions (FLLs) by shearwave elastography (SWE). Methods: We used SWE in 108 patients with 161 FLLs and in the adjacent liver for quantitative and qualitative FLLs stiffness assessment. The Mann-Whitney test was used to assess the difference between the groups of lesions where a P value less than 0.05 was considered significant. Results: SWE acquisitions failed in 22 nodules (14 %) in 13 patients. For the 139 lesions successfully evaluated, SWE values were (in kPa), for the 3 focal fatty sparings (FFS) 6.6 ± 0.3, for the 10 adenomas 9.4 ± 4.3, for the 22 haemangiomas 13.8 ± -5.5, for the 16 focal nodular hyperplasias (FNHs) 33 ± -14.7, for the 2 scars 53.7 ± 4.7, for the 26 HCCs 14.86 ± 10, for the 53 metastasis 28.8 ± 16, and for the 7 cholangiocarcinomas 56.9 ± 25.6. FNHs had significant differences in stiffness compared with adenomas (P = 0.0002). Fifty percent of the FNHs had a radial pattern of elevated elasticity. A significant difference was also found between HCCs and cholangiocarcinomas elasticity (P = 0.0004). Conclusions: SWE could be useful in differentiating FNHs and adenomas, or HCCs and cholangiocarcinomas by ultrasound. Key Points: • Elastography is becoming quite widely used as an adjunct to conventional ultrasound • Shearwave elastography (SWE) could help differentiate adenomas from fibrous nodular hyperplasia • SWE could also be helpful in distinguishing between hepatocellular carcinomas and cholangiocarcinomas • SWE could improve the identify hepatocellular carcinomas in cirrhotic livers © 2012 European Society of Radiology. Source

Chalayer E.,Service de Medecine Interne | Bachy E.,Center Hospitalier Lyon Sud | Occelli P.,Pole Information Medicale Evaluation Recherche | Weiler L.,Center Hospitalier Lyon Sud | And 5 more authors.
QJM | Year: 2015

Aim: To assess the clinical features and outcome of lymphoma when associated with sarcoidosis and to determine whether this association gives lymphoma a better prognosis. Design: Multicentre retrospective cohort study. Methods: Retrospective chart review. Results: Twenty-one patients were included (9 males, 12 females). Median age at sarcoidosis diagnosis was 48 years (range: 24-68 years). In 14 cases, lymphoma occurred within a previously known sarcoidosis. Five patients received a concomitant diagnosis of sarcoidosis and lymphoma, whereas lymphoma preceded sarcoidosis in two patients. Three patients were diagnosed with Hodgkin's lymphoma and 18 patients with non-Hodgkin's lymphoma (diffuse large B-cell lymphoma (DLBCL) (n = 11), follicular lymphoma (n = 2), chronic lymphocytic leukemia/small lymphocytic lymphoma (n = 2), anaplastic large cell lymphoma ALK + (n = 1), angioimmunoblastic T-cell lymphoma (n = 1) and T-cell prolymphocytic leukemia (n = 1)). Thirteen patients were alive and in complete remission. Median age at the time of diagnosis of sarcoidosis was lower in patients with concomitant lymphoma compared with patients with sarcoidosis preceding lymphoma (34 years vs. 51 years, P = 0.01). Patients presenting with DLBCL associated with sarcoidosis were compared with DLBCL without sarcoidosis. No statistical difference was found in the risk of death or progression between the two groups (P = 0.685). Conclusions: We report here the largest series of lymphoma associated sarcoidosis patients. As opposed to previous studies, we observed a predominance of patients with DLBCL. Our study confirms the concept of the sarcoidosis-lymphoma syndrome. Large B-cell lymphoma does not have a better prognosis when associated with sarcoidosis. © The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. Source

De Lattre C.,Pediatric Neuromuscular Disease Reference Center | Payan C.,Hopital Pitie Salpetriere | Vuillerot C.,Pediatric Neuromuscular Disease Reference Center | Rippert P.,Pole Information Medicale Evaluation Recherche | And 3 more authors.
Archives of Physical Medicine and Rehabilitation | Year: 2013

Objective: To validate a useful version of the Motor Function Measure (MFM) in children with neuromuscular diseases aged <7 years old. Design: Two prospective cohort studies that documented the MFM completion of children aged between 2 and 7 years old. Setting: French-speaking rehabilitation departments from France, Belgium, and Switzerland. Participants: Healthy children (n=194) and children with a neuromuscular disease (n=88). Interventions: Patients were rated by the MFM either once or twice by trained medical professionals, with a delay between the 2 MFMs ranging between 8 and 30 days. Main Outcome Measure: Intra- and interrater reliability of the MFM. Results: The subtests making up the MFM-32, a scale monitoring severity and progression of motor function in patients with a neuromuscular disease in 3 functional domains, were carried out in healthy children aged 2 to 7 years. Twenty items of the MFM-32 were successfully completed by these children and were used to constitute the MFM-20. Principal component analysis of the MFM-20 confirmed the 3 functional domains. Inter- and intrarater reliability of the 3 subscores and total score were high (intraclass correlation coefficient >.90), and discriminant validity was good. Conclusions: The MFM-20 can be used as an outcome measure for assessment of motor function in young children with neuromuscular disease. © 2013 by the American Congress of Rehabilitation Medicine. Source

Duclos A.,Pole Information Medicale Evaluation Recherche | Duclos A.,University of Lyon | Voirin N.,CNRS Biometry and Evolutionary Biology Laboratory
International Journal for Quality in Health Care | Year: 2010

Background: The p-chart is a user-friendly tool for monitoring adverse events. By converting data into knowledge, it is helpful in interpreting and reducing sources of variability in care. Certain basics for developing expertise to use p-charts correctly are necessary. Purpose: This paper provides key elements on how to develop and interpret a p-chart for clinical practice, how to successfully integrate this tool within a comprehensive approach, and how to report a study based on p-chart utilization. P-chart building: The p-chart combines time series analysis with a graphical presentation of data by plotting successive indicator measurements in chronological order. The pragmatic choice of well-defined indicators to be monitored is essential. Exact control limits based on the binomial distribution and the incorporation of risk adjustment represent important contributions for further improving the tool's performance in health-care settings. P-chart implementation: The solution needed to reduce adverse events is not available from measurement alone. The success of routine introduction of the p-chart requires investigation of the causes of indicator variations and the trying out of quality improvement initiatives. It must be supported by strong management leadership within an atmosphere of constructive evaluation. Perspectives: The implementation of the p-chart into clinical practice encourages practitioners to continuously undertake a critical examination of the care delivered. Nearly a century after it was created in the manufacturing industry, the control chart now contributes to improving the quality of health-care processes and patient safety. © The Author 2010. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved. Source

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